Think about taking a piece of uncooked spagetthi and snapping it in half. As you begin bending the piece of pasta, there is a certain range where if you stopped it would go back to normal (this is the area up to the “yield stress” on the graph). At some point, if you continue to bend the noodle it will either break or be unable to return to the normal range (this is the UTS region on the graph). This how we generally define how strong a bone is, but this fails to represent how three dimensional forces are applied to the human skeleton.
Petit’s article tells us that using DXA scans as a clearing examines for bone health is too simplistic. Petit states, “To adequately evaluate bone strength in children, we would ideally want to incorporate components of bone strength from the material level, the tissue level, and the whole bone level.”
Petit M, Beck T and Kontulainen S. Examining the developing bone: What do we measure and how do we do it? Musculoskelet Neuronal Interact 2005; 5(3):213-224 2015.
Warden S, Davis I and Fredericson M. Management and Prevention of Bonse Stress Injuries in Long-Distance Runners. Orthop Sports Phys Ther 2014;44(10):749-765. Epub 7 August 2014. doi:10.2519/jospt.2014.5334
Baxter-Jones A, Faulkner R, Forwood M et al. Bone mineral accrual from 8 to 30 years of age: An estimation of peak bone mass. Journal of Bone and Mineral Research, Vol. 26, No. 8, August 2011, pp 1729–1739
Langendonck L, Lefevre J, Claessens A et al. Influence of Participation in High-Impact Sports during Adolescence and Adulthood on Bone Mineral Density in Middle-aged Men: A 27-Year Follow-up Study Am J Epidemiol 2003;158:525–533
Kraus E, Tenforde A, Nattiv A et al. Bone stress injuries in male distance runners: higher modified Female Athlete Triad Cumulative Risk Assessment scores predict increased rates of injury. Kraus E, et al. Br J Sports Med 2018;0:1–7. doi:10.1136/bjsports-2018-099861